Orbital

This was from a 52 year old male with a recent surgical history of vitreous detachment that became a retinal detachment. He presented to the emergency room for vision changes in same eye after an object fell and hit his head. Ocular ultrasound was performed at the bedside which revealed a new vitreous detachment. Important to note here that it is crucial to fan/tilt through the entire eye, making sure to visualize the optic nerve in order to differentiate between a vitreous and retinal detachment. In this case, notice how the lesion spotted in the chamber does not connect to the optic nerve, which is consistent with a vitreous detachment.

Dr. Christopher Paulo, DO, PGY-1

Riverside Regional Medical Center Emergency Medicine Program (Newport News, VA)

A 44 year old man came to ED with a shimmering effect in his left eye and unilateral temporary painless visual disturbance. He had previously been treated for a retinal tear.

Ocular PoCUS shows a frond-like linear structure lifting away from the posterior surface of the globe.

Posterior vitreous detachment (PVD) was suspected while retinal detachment (RD) was also considered. PVD was confirmed by the specialist team and the patient was treated conservatively.

Dr. Cian McDermott, Emergency Physician - University Hospital Geelong, Australia

40 year old male with 6 months of decreased vision from his left eye. No pmh or history of trauma. VA was obviously decreased relative to the contralateral eye. POCUS rapidly revealed a freely floating hyperechoic membrane consistent with vitreal detachment. To differentiate between a vitreous and retinal detachment you must look to see if the membrane is attached to the hypoechoic optic nerve. The retinal is continuous with the optic nerve therefore stays attached to the optic nerve in a retinal detachment. A vitreous detachment would be completely untethered as seen in this image. You can also see the “washing machine sign” better pictured in other images in this gallery.

Matt Riscinti, MD Bryan Flores, MD - Kings County Emergency Medicine